Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia.
BACKGROUND
Ventilator-associated pneumonia (VAP) is widely recognized as a serious and common complication associated with high morbidity and high costs. Given the complexity of caring for heterogeneous populations in the intensive care unit (ICU), however, there is still uncertainty regarding how to diagnose and manage VAP.


OBJECTIVE
We recently conducted a national collaborative aimed at reducing health care-associated infections in ICUs of hospitals operated by the Hospital Corporation of America (HCA). As part of this collaborative, we developed algorithms for diagnosing and treating VAP in mechanically ventilated patients. In the current article, we (1) review the current evidence for diagnosing VAP, (2) describe our approach for developing these algorithms, and (3) illustrate the utility of the diagnostic algorithms using clinical teaching cases.


METHODS
This was a descriptive study, using data from a national collaborative focused on reducing VAP and catheter-related bloodstream infections.


METHODS
The setting of the study was 110 ICUs at 61 HCA hospitals.


METHODS
None.


RESULTS
We assembled an interdisciplinary team that included infectious disease specialists, intensivists, hospitalists, statisticians, critical care nurses, and pharmacists. After reviewing published studies and the Centers for Disease Control and Prevention VAP guidelines, the team iteratively discussed the evidence, achieved consensus, and ultimately developed these practical algorithms. The diagnostic algorithms address infant, pediatric, immunocompromised, and adult ICU patients.


CONCLUSIONS
We present practical algorithms for diagnosing and managing VAP in mechanically ventilated patients. These algorithms may provide evidence-based real-time guidance to clinicians seeking a standardized approach to diagnosing and managing this challenging problem.
Wall
Richard J
RJ
Pulmonary, Critical Care and Sleep Disorders Medicine, Southlake Clinic, Valley Medical Center, Renton, Washington 98055, USA. brickw@u.washington.edu
Ely
E Wesley
EW
Talbot
Thomas R
TR
Weinger
Matthew B
MB
Williams
Mark V
MV
Reischel
Joan
J
Burgess
L Hayley
LH
Englebright
Jane
J
Dittus
Robert S
RS
Speroff
Theodore
T
Deshpande
Jayant K
JK
D000465:Algorithms; D019317:Evidence-Based Medicine; D006777:Hospitals, Proprietary / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012122:Ventilators, Mechanical / Q000009:adverse effects*